Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft

Abstract

Posterior glenoid reconstruction using distal tibia allograft is an available technique for the treatment of posterior shoulder instability with glenoid bone loss. A key aspect to this procedure relies on maintaining complete control of the graft during insertion and securement to the posterior glenoid. Although there are commercially available products to aid with graft control, we describe a novel graft transfer technique that is compatible with all cannulated systems for maintaining positive graft control. This technique allows the surgery to be performed in an arthroscopic manner using current instrumentation for open glenoid reconstruction.

Arthroscopic Posterior Glenoid Reconstruction Using a Fresh Distal Tibia Allograft for Recurrent Posterior Instability

“…Others have advocated for the use of a double-barreled cannula to facilitate with graft positioning and fixation. 7 To address the difficulties associated with intra-articular delivery and manipulation of the graft, Parada and Shaw 16 recently proposed a technique that uses a dual-cannulated graft positioner (Arthrex) and 3-0 PROLENE suture to secure the graft to the positioner and allow for easy, intra-articular passage of the graft and instrument removal once secured in place. This low-cost approach allows for facilitated guidewire placement and subsequent suture removal before cannulated screw insertion.…”

“…Various techniques have been described to facilitate graft delivery using different drill guides, Kirschner wires, and suture augmentation. 4,5,7,10,16 We describe an all-arthroscopic technique for posterior glenoid reconstruction using a fresh DTA fixation, in conjunction with an arthroscopic Latarjet fixation set (Bristow-Latarjet Instability Shoulder System; DePuy Mitek, Inc., Raynham, MA), using 2 partially threaded screws in a patient with recurrent posterior shoulder instability, static posterior humeral head subluxation, and associated glenoid bone loss.…”

Arthroscopic “Bone Block Cerclage” Technique for Posterior Shoulder Instability

“…[31][32][33] Moreover, although technically demanding, this technique has been shown to be reliable in restoring glenohumeral contact pressure and having very good clinical results. 34,35 We present an arthroscopic anatomical metal-free bone block fixation technique (Fig 13 A and B) with capsule labral reconstruction for posterior shoulder instability. With this technique, we are able to eliminate problems related to the traditional bone fixation with screws or buttons, where bone remodeling can eventually lead to exposure of the metal implant and therefore result in a painful but stable shoulder.…”

“… 31 , 32 , 33 Moreover, although technically demanding, this technique has been shown to be reliable in restoring glenohumeral contact pressure and having very good clinical results. 34 , 35 …”

Variations in the Anatomic Morphology of the Lateral Distal Tibia: Surgical Implications for Distal Tibial Allograft Glenoid Reconstruction

“…The same group of authors later demonstrated that use of DTA produced similar contact mechanics as the iliac crest when used to reconstruct posterior glenoid defects. 10 Glenoid reconstructive procedures with DTA have now been reported for anterior and posterior glenoid defects and can be performed with open 20 and arthroscopic 19 techniques.…”